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General NPI Number Information
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NPI Number | 1427830504
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Entity Type | Individual
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Provider Name | BRYANT LEE MOORE
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Gender | Male
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 251 ELM ST
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City | CLAREMONT
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State | NH
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Zip | 03743-4940
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Country | US
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Telephone | 603-865-1321
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Fax |
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Provider Business Mailing Address
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Address Line | 21 MAIN ST APT 3
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City | WEST LEBANON
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State | NH
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Zip | 03784-1695
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Country | US
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Telephone | 205-245-4624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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